James John T
Patient Safety America, Houston, TX, USA.
J Patient Exp. 2022 Jun 7;9:23743735221106599. doi: 10.1177/23743735221106599. eCollection 2022.
Legally and ethically physicians must provide information to patients so they may make an informed decision about invasive procedures. The problem is who decides what information to provide. Is it the reasonable patient or the reasonable physician? Individual patients and individual physicians may differ from the norm on what is reasonable. This problem may be solved by shared decision-making in which the preferences of the patient and the probability-based knowledge of the physician are used to co-produce an optimal choice. Currently, patients are seldom prepared to engage in shared decision-making, and vestiges of meaningless "informed consent" are common. The present case study illustrates how "reasonable person" survey data may be used by a patient to engage in probability-based, shared decision-making with a surgeon planning to perform a laminectomy. Recommendations include probability-based, shared decision-making training for patients and physicians and improved documentation to facilitate learning.
在法律和伦理层面，医生必须向患者提供信息，以便他们能够对侵入性手术做出明智的决定。问题在于由谁来决定提供哪些信息。是理性的患者还是理性的医生呢？个体患者和个体医生对于何为合理的看法可能与常态有所不同。这个问题可以通过共同决策来解决，即利用患者的偏好和医生基于概率的知识共同做出最优选择。目前，患者很少愿意参与共同决策，无意义的“知情同意”残余现象很常见。本案例研究说明了患者如何利用“理性人”调查数据与计划进行椎板切除术的外科医生进行基于概率的共同决策。建议包括为患者和医生提供基于概率的共同决策培训，并改进记录以促进学习。
